Exophytic papilloma: squamous subtype

Case contributed by Dr Henry Knipe

Presentation

Follow-up previously treated extensive SCC of head and neck 20 years ago with primary chemotherapy / radiation therapy. Also has known right multinodular goitre.

Patient Data

Age: 60
Gender: Female

Soft tissue density mass arising from the posterior wall of the nasopharynx. 

Centred in the midline of the posterior nasopharynx is a 28 x 18 x 17 mm soft tissue mass, which is hyperintense on T2, hyperintense on T1 with mildly heterogeneous post contrast enhancement. It abuts the pre-vertebral fracture with no evidence of deep extension.

Asymmetric soft tissue thickening is some enhancement is seen in the region of the left tonsillar fossa, presumably secondary to previously treated SCC. Right sided goitre with deviation but no narrowing of the trachea.

Patient proceeded to panendoscopy and core biopsy of the nasopharyngeal mass. 

Histopathology:

MICROSCOPIC DESCRIPTION:

The biopsies show exophytic lesions with underlying stroma comprising broad papillae lined by stratified squamous mucosa. There is prominent surface erosion and numerous intraepithelial neutrophils and lymphocytes. There is no dysplasia and no evidence of malignancy.

DIAGNOSIS: Right and left nasopharyx: Benign squamous papilloma(s).

Case Discussion

Exophytic squamos papillomas, along with inverted and oncocytic papillomas, are a type of Schneiderian papilloma. The main differential in this case of nasopharyngeal carcinoma, especially given the history of previous HNSCC. Given the enhancement of the mass, sinonasal polyps should not be considered. 

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Case information

rID: 45959
Case created: 14th Jun 2016
Last edited: 14th Jun 2016
System: Head & Neck
Inclusion in quiz mode: Included

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